Provider Demographics
NPI:1689023319
Name:MCMAHAN, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S WASHINGTON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6656
Mailing Address - Country:US
Mailing Address - Phone:630-518-2525
Mailing Address - Fax:855-518-2525
Practice Address - Street 1:140 E LOOP RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8407
Practice Address - Country:US
Practice Address - Phone:312-702-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist